When I moved from the UK to Aus­tralia in 2013, work­ing as a nurse in remote Aus­tralia was a dream job that soon became my real­i­ty. Over the last ten years, I have prac­tised in var­i­ous com­mu­ni­ties around Cape York and the East and West Kim­ber­ley. Five years ago, I found my call­ing when I tran­si­tioned into a sex­u­al and repro­duc­tive health role. I felt as though this role was all I was ever sup­posed to do and work­ing so close­ly with the com­mu­ni­ty has been a priv­i­lege. I realised that remote work is not for the faint-heart­ed and I quick­ly had my eyes opened to the unique chal­lenges that preg­nant peo­ple face when access­ing repro­duc­tive health­care, specif­i­cal­ly Med­ical Ter­mi­na­tion of Preg­nan­cy (MToP).

Under­stand­ing Med­ical Ter­mi­na­tion of Preg­nan­cy (MToP)

In Aus­tralia, the MS 2‑Step reg­i­men is used for ear­ly MToP. This involves two med­ica­tions: mifepri­s­tone (Step 1), which halts the pro­gres­sion of preg­nan­cy, and miso­pros­tol (Step 2), which induces uter­ine con­trac­tions and cer­vi­cal dila­tion to expel the preg­nan­cy tis­sue (MS Health, 2023). The MS 2‑Step is approved for use up to 63 days ges­ta­tion, mak­ing ear­ly access to health­care ser­vices crucial.

Due to these reg­u­la­tions, MToP is extreme­ly time-sen­si­tive, and miss­ing the win­dow leaves clients with no alter­na­tive but to con­tin­ue with the preg­nan­cy or opt for sur­gi­cal ter­mi­na­tion of preg­nan­cy (SToP). In remote com­mu­ni­ties SToP requires long-dis­tance trav­el, mean­ing clients are required to spend time away from their friends, fam­i­ly, and com­mu­ni­ty. I per­son­al­ly have wit­nessed clients’ trau­ma asso­ci­at­ed with inter­state hos­pi­tal trans­fers and know that this acts as a sig­nif­i­cant deter­rent to seek­ing care. Some preg­nant indi­vid­u­als I’ve worked with have even become lost to fol­low-up when trav­el for a sur­gi­cal ter­mi­na­tion was required.

Bar­ri­ers to access­ing ter­mi­na­tion services

Research and clin­i­cal prac­tice show that preg­nant peo­ple in rur­al and remote Aus­tralia face dis­pro­por­tion­ate chal­lenges com­pared to their coun­ter­parts in met­ro­pol­i­tan areas. The bar­ri­ers to access­ing repro­duc­tive health­care in these regions are mul­ti­fac­eted and con­tribute to poor­er health out­comes. In some cas­es, the lack of access to ter­mi­na­tion ser­vices means that clients have no oth­er choice but to con­tin­ue with unwant­ed preg­nan­cies, which can have a pro­found and last­ing impact on their men­tal health.

Chron­ic health­care staff short­ages result in extend­ed wait times for clients. Often, they have fam­i­ly at home which they are required to care for, or they need to pick up their chil­dren from school mean­ing they have min­i­mal time to wait at the health ser­vice to be seen. 

I have also worked with clients where inti­mate part­ner vio­lence and repro­duc­tive coer­cion are fac­tors they need to nav­i­gate and nego­ti­ate when seek­ing health care. Under­stand­ing that this is a real part of people’s lives offers us the chance as clin­i­cians to work using an inter­sec­tion­al lens and under­stand that access to care is not always easy for clients and that we need to be flex­i­ble, empa­thet­ic and trau­ma-informed in our practice.

The cru­cial role of pri­ma­ry healthcare

Pri­ma­ry health­care is essen­tial in pro­vid­ing time­ly and appro­pri­ate care to improve health out­comes for indi­vid­u­als seek­ing ter­mi­na­tion ser­vices. How­ev­er, chron­ic staff short­ages and a lack of clin­i­cian con­fi­dence in pro­vid­ing infor­ma­tion often result in delays and dif­fi­cul­ties access­ing nec­es­sary care.

While work­force short­ages may be beyond our imme­di­ate con­trol, under­stand­ing our clients’ unique needs through an inter­sec­tion­al lens is with­in our power.

By tak­ing the time to under­stand the social, cul­tur­al, and phys­i­cal fac­tors that ham­per access to care, we can work towards deliv­er­ing com­pas­sion­ate, eth­i­cal care that meets the stan­dards our clients deserve.

We as health work­ers can play a piv­otal role in advo­cat­ing for improved access to ter­mi­na­tion ser­vices. We work to forge close rela­tion­ships with the com­mu­ni­ty to build trust and sup­port in address­ing client-spe­cif­ic needs and bar­ri­ers and solu­tions to these.

Mov­ing forward

My jour­ney as a sex­u­al and repro­duc­tive health nurse has led me to under­take a Mas­ter of Sex­u­al and Repro­duc­tive Health. Hav­ing now com­plet­ed this, I have tran­si­tioned into train­ing to become a nurse prac­ti­tion­er. I hope to con­tribute to improv­ing repro­duc­tive health ser­vice deliv­ery for indi­vid­u­als who live in rur­al and remote Aus­tralia and want to access MToP. Whilst increas­ing the num­ber of clin­i­cians who can deliv­er this care safe­ly and com­pe­tent­ly is just one piece of the puz­zle, it is a start.

For those of you who just want to learn more about ways to upskill in this area, there are many organ­i­sa­tions ded­i­cat­ed to improv­ing access. Chil­dren by Choice is an inde­pen­dent, not-for-prof­it, pro-choice organ­i­sa­tion that offers sup­port to clients (QLD only) and pro­vides low-cost train­ing for health pro­fes­sion­als on repro­duc­tive coer­cion, abor­tion coun­selling and repro­duc­tive rights.

— Lau­ra Berry, Men­tal Health & Well­be­ing Edu­ca­tor CRANAplus